Think you know everything you need to know about STIs? You might be surprised.

There is a lot of misinformation about sexual health and STIs (sexually transmitted infections) running amok. You’ve probably heard some of them (such as the myth that you can get an STI from a toilet seat). Here is Jenelle Marie, founder of the The STD Project, equipped to bust four common myths about STIs that all of us have heard before, and too many of us continue to believe.

Here are four myths about STIs that you need to watch out for:

1) A lot of people believe contracting an STI won’t happen to them. The fact is that STIs are common. 1 in 2 people will contract an STI before the age of 25.
2) Most STIs are asymptomatic and most people who have an infection are not aware of it.
3) Contrary to popular belief, oral and anal sex are not safer forms of sex. Both pose STI risks.
4) Even if you and your partner have been tested for STIs there are still risks. It’s impossible to be tested for everything. There are several common STIs for which there are either no commercial tests, or for which the tests are only accurate during an outbreak.

Safer sex—comprehensive safer sex, that is—includes more than just using barriers consistently and correctly. You also need to talk about risk in advance of any sexual activity.

That’s where most people get stuck. As soon as someone utters the letters S-T-I (short for sexually transmitted infection) in sequence, people run for the hills. It can be especially daunting to bring up STIs with someone you don’t know very well. And even if you’ve known the person for forever, that conversation can still be awkward.

1. An STI won’t happen to me.

Think you don’t need to go there? Think again. The most common myth about STIs is that they won’t happen to you—they only happen to certain kinds of people, right? Not right. STIs don’t categorize people like we do.

The truth is, 1 in 2 people will contract an STI by the time they reach the age of 25—some curable, some not. An astounding 20 million people in the U.S. contract an STI every year, and those are only the STIs which get reported. That number is likely much higher due to under-reporting and many STIs not getting reported at all—some are diagnosed visually, and others are not documented by the Centers for Disease Control and Prevention (CDC). Of the 30-plus STIs out there, the CDC only reports on about 8 of them. Things like pubic lice, scabies, and HPV infections among guys are not part of those numbers.

In so far as HPV is concerned, outside of the visual symptoms of genital warts caused by low-risk HPV strains, there’s no way to know if a man has it since he can’t be tested for it. This is shocking, I know—and it’s one of the reasons why by the age of 50, at least 80% of women will have acquired the infection.

Keep in mind, HPV is transmitted via skin-to-skin contact, so even the most careful barrier-user is still at risk of contracting HPV, because barriers do not always cover all contact areas. If you’re under 26, another good option for preventing HPV is Gardasil, a vaccine that protects against the four most common HPV strains.

2. I’ll know if I get an STI—or if someone I’m seeing has one.

It’d be great if you could tell who had an STI and who didn’t, if we (I’m living with genital herpes) wore some kind of warning label or if you knew just by the type of person we were. On the other hand, I’m not a big fan of “scarlet-lettering”; it didn’t bode well for Hester Prynne, and it doesn’t suit the vast number of people living with an STI, especially since most are actually entirely unaware they have one.

When STIs are asymptomatic or exhibiting mild symptoms, they’re still transmittable to others—and there’s no guarantee the STI will remain asymptomatic in the newly infected individual. Recognizable symptom or not, STIs can wreak havoc internally long before we’re aware of their effects; untreated asymptomatic STIs can pose long-term health risks like liver damage (eg. Hepatitis) and infertility (eg. Chlamydia and Gonorrhea).

Contrary to popular belief, things like appearance and cleanliness are not indicators of infection—outside the obvious visible symptoms when they’re present. Hygiene is still important to help safeguard you against things like the common cold and the flu, of course, but some traditional practices such as douching after sex or brushing your teeth after a make-out session can actually make you more susceptible to STIs.

3. If I just do oral/anal sex or have sex with a virgin, I’m safe.

Anal sex might seem like a viable option if you’re concerned about pregnancy or losing your virginity in the traditional vaginal penetration sense; however, unprotected anal sex poses one of the highest STI risks. The anal cavity is comprised of permeable mucous membranes which can provide an entry point for infection. Due to the nature of sexual activity involving the anus, small tears and cuts are common—especially if you’re not using enough lube—so, additional points of entry present infection opportunities.

Choosing to have oral sex or engaging in activities with someone who’s only had oral sex might also seem like a way to lower your risk, but the risk of contracting an STI is still high. The mouth too is made up of mucous membranes, and something as common as a cold sore—herpes (usually HSV1)—can be transmitted to the genitals or vice versa.

4. We’ve both been tested, so we’re safe.

Getting tested is really important. But even if someone says they’ve been tested—and definitely if they say they’ve been tested for all STIs—it’s important to ask additional questions.

Anyone who says they’ve been tested for all STIs and is “clean” is giving you incorrect information right off of the bat. Not all STIs can be tested for—for some there just aren’t tests, or they can only be diagnosed if there are visual symptoms. Even most comprehensive STI tests only test for a handful of STIs—usually HIV, syphilis, chlamydia, and gonorrhea.

The Take-Away.

If you have fallen prey to one or more of these myths, don’t beat yourself up. Most people think they know about STIs because they’ve heard a lot of misleading information. I was one of them. Before I contracted genital herpes at a young age, I thought STIs only happened to certain types of people. I thought I was practicing “safe” sex by getting on the pill and I had no idea of the level of risk involved in my sexual activities while I was still a virgin in the traditional sense—and even later, once I became “officially” sexually active. To hear more of my story and to gather some practical tips about how to practice comprehensive safer sex, read my 3-part series on Bedsider’s Tumblr!

THE STD PROJECT is a multi-award-winning independent website and progressive movement eradicating STD stigma by facilitating and encouraging awareness, education, and acceptance through story-telling and resource recommendations. Fearlessly led by Founder, Jenelle Marie, The STD Project is committed to modern-day sexual health and prevention by advocating for conscientious and informed decisions. Find them on twitter @theSTDProject

BEDSIDER is an online birth control support network for women operated by The National Campaign to Prevent Teen & Unplanned Pregnancy. Bedsider is totally independent (no pharmaceutical or government involvement). Honest and unbiased, Bedsider’s goal is to help women find the method of birth control that’s right for them and learn how to use it consistently and effectively, and that’s it.Find Bedsider on twitter @Bedsider

If you were recently exposed to genital warts would you know what to do? Do you know what to ask your doctor? What tests and treatments are available? Are genital warts curable?

As part of their weekly Q&A series, the CSPH (the Center for Sexual Pleasure and Health) explains what to do if you think you’ve been exposed to genital warts, a common sexually transmitted infection caused by the human papillomavirus (HPV). HPV is so common, it has been called the “common cold” of STIs in the United States.

According to the CDC, the United States is facing an HPV epidemic, in which 50% of sexually active adults carry some form of HPV without any symptoms. Yet not enough people know what is HPV, what are it’s sympotoms (if any!), and how it can be treated and prevented.

Because genital warts spreads by skin-to-skin contact rather than an exchange of bodily fluids, condoms are not 100% effective at preventing transmission.

Unlike many STIs which can be diagnosed with a simple blood test, genital warts are detected primarily through visual inspection. However, not everyone shows symptoms.

About two-thirds of people who are exposed to active genital warts will develop them, usually within three to six months after contact.

You can reduce the risk of HPV with consistent use of sex dams and condoms, creative outercourse that doesn’t put you in direct contact with genitals (dry humping, vibrator play, etc.), and regular STI testing to keep your status up-to-date.

Each week, The CSPH answers questions asked on our site and through social media outlets like Twitter, Tumblr, and Facebook. This week’s question is:

Hi! I just recently found out that I was exposed to genital warts and might have it, though I am currently not showing any symptoms. I have a pap smear coming up at the beginning of August and I plan to bring up my concerns then (while abstaining from sex until then). Do you think that they’ll be able to test me although I don’t have any symptoms, only reasonable concern?

Genital warts is a common sexually transmitted infection caused by the human papillomavirus (HPV), which is spread by skin-to-skin contact rather than an exchange of bodily fluids. About one person in 10 will have genital warts at some time in their life. Unfortunately, this sneaky virus can be passed along even if you use a condom—for example, if your genitals touch during foreplay, or if your partner masturbates before fondling your naughty bits. Condom use is still recommended, as safer sex practices can significantly decrease risk, but it should be remembered that barrier methods are not a genital force field.

While HPV is a family of viruses often linked to cervical cancer, the particular strains that cause genital warts are different and distinct. With more than 100 permutations, the volume and variety of HPV could rival Nicki Minaj’s wig collection. Most genital warts, however, are caused by HPV types 6 and 11, which are lower risk but highly contagious. About two-thirds of people who are exposed to active genital warts will develop them, usually within three to six months after contact.

Thanks to high school health class, some people might associate genital warts with magnified images of mutant cauliflower, but in most cases these warts are inconspicuous, subtle, and benign. They can be flesh-toned or gray, raised or flat, singular or in clusters. For vulva-owners, these growths tend to appear on the vagina or cervix or around the labia majora, anus, or inner thighs. A pelvic exam is often necessary for diagnosis, since warts do not usually cause pain or discharge and can reside internally. Genital warts in penis-owners may surface on the shaft, scrotum, testicles, anus, or general groin area.

Unlike HIV and syphilis which can be diagnosed with a simple blood test, genital warts are detected primarily through visual inspection. No lab results can indicate the presence or absence of HPV 6 or 11 before genital warts appear. Once a skin growth is present, a biopsy may be required for confirmation since smaller warts can be difficult to distinguish from normal genital bumps or ingrown pubic hair.

Although there is an HPV test on the market, it was designed to detect high-risk, pre-cancerous strains of the virus (types 16 and 18) in women over thirty. Similarly, a pap smear would not reveal whether or not someone has genital warts. Due to a lack of effective screening and testing, it is hard to know if you or a potential partner might have this contagious, but harmless, skin condition; an estimated 50% of sexually active adults carry some form of HPV without any symptoms.

Fortunately, the Gardasil vaccine can protect against the HPV strains responsible for 90% of genital warts, in addition to the high-risk types associated with 75% of cervical cancers. No longer restricted to empowered women and girls who engage in radical activities like playing drums, skateboarding, or living in designer lofts, this vaccine is now available to members of all sexes and genders. While there are risks and benefits associated with Gardasil (or any vaccine), the recommended age of inoculation is 11 or 12, or prior to becoming sexually active.

The CDC recommends that vulva-owners ages 13 through 26 get HPV vaccine if they have not received any or all of the three doses when they were younger. Likewise, CDC recommends the vaccine for penis-owners aged 13 through 21 years if they have not been received it already.

If you happen to have genital warts, there are several treatment options available, including podophyllin solution, cryosurgery (freezing), and electrocaudery (burning). You can also wait and give the warts some time to disappear on their own; within three months, 20 to 30 percent of all cases of non-cervical warts usually clear up without medical intervention.

When genital warts are treated, symptoms often resolve within one to nine months. Although the virus is most easily spread when active warts are present, you may still be contagious following treatment or removal, especially during the six months immediately afterwards. If you have been with your current partner since a few weeks before the genital warts appeared, more than likely your partner has already been exposed to the virus and abstaining would not prevent an outbreak. However, before engaging with new partners, it would be important to discuss the risk of viral transmission (in addition to what turns you on!), and to use condoms until everyone is comfortable with the potential consequences.

Unfortunately, there is no way for your doctor to conclusively diagnose you with genital warts unless physical symptoms are present. However, it’s wonderful that you’re being responsible in the meantime by abstaining from sex and initiating dialogue on these important issues. Through consistent use of barrier methods, creative outercourse (dry humping, vibrator play, etc.), open communication, and annual exams with a qualified healthcare provider, you can take several proactive measures to help reduce your risk of genital warts and other STIs, while enjoying safe and sexy pleasure adventures.

Special note: Human papilloma virus (HPV), the underlying agent that causes genital warts, actually has over 100 strands, about forty of which can lead to genital warts. Other strains of HPV can also lead to cell division, which may be responsible for a number of throat, genital, cervical, and anal cancers. According to the CDC, nearly all sexually active adults will get at least one strain of HPV at some point in their life; however, when we state the “one person in ten” statistic, we were referring to having genital warts specifically.

The CENTER for SEXUAL PLEASURE and HEALTH (The CSPH) is designed to provide adults with a safe, physical space to learn about sexual pleasure, health, and advocacy issues. Led by highly respected founder and director, Megan Andelloux, The CSPH is a sexuality training and education organization that works to reduce sexual shame, fight misinformation, & advance the sexuality field.

Many (both teens and adults alike) believe oral sex to be the safe alternative to vaginal and anal intercourse. However, the truth is that although less risky, it certainly is not completely safe. STIs, like HPV and Herpes are the top risks when engaging in unprotected oral sex.

A little education goes a long way though, and it only takes a few necessary steps to keep yourself protected.

This article by The Center for Sexual Pleasure & Health (The CSPH) covers the following points:

HPV and Herpes are contracted through skin-to-skin contact.

HPV is the leading cause of throat cancer above even tobacco use.

Gonorrhea and chlamydia are common STIs transmitted during oral sex but are relatively easy to treat.

HIV can be transmitted during oral sex although it’s extremely rare. There are only a few proven cases of this mode of HIV transmission in the world.

A cut or sore in the mouth greatly increases the risks of infections passing during oral sex.

Ahh, the good ol’ Lewinski, giving dome, eating peaches, carpet munching, knob-polishing, and court-addressing. Many of us are familiar with oral sex (and its various slang affiliates!), but considerably fewer of us have a comprehensive understanding of how to safely engage in mouth-led southern explorations.

Image from the CSPH

The common perception of oral sex is that it is a risk-free sex act. This belief is most accepted among young adults and adolescents, many of whom engage in oral sex before other forms of intercourse as a deliberately risk-preventative measure. Indeed, while penis-in-vagina sex is often understood as potentially resulting in exposure to sexually transmitted infections and pregnancy, oral sex is mostly contextualized as wholly safe. This results in people of all ages being less cautious in their oral sex forays by not utilizing safer sex materials, thereby putting them at greater risk for STI transmission.

With that said, it is in fact true that oral sex is less risky than other sexual activities insofar as pregnancy and STI transmission. However, this doesn’t mean that we should all be giving and receiving oral sex without appropriate safety measures. Unprotected oral sex can result in the contraction of a number of sexually transmitted infections, and while there has yet to be research published on the risk of all STIs during oral sex, a closer look at individual infections proves to be enlightening.

There are two primary STI risks in engaging in unprotected oral sex: herpes simplex and human papillomavirus, also known as HPV. As I discussed in Q&A: Herpes, some 50 to 80% of adults have herpes simplex virus 1 (HSV-1), also known as cold sores. Despite its colloquial framing as “oral herpes,” HSV-1 can also be transmitted to genitals, with up to half of new genital herpes contractions occurring as a result of HSV-1. Unlike most STIs, herpes is not curable, and while there is no shame in contracting HSV, which is in many ways a simple skin condition that flares up occasionally, most individuals would prefer to not deal with it.

Like herpes, HPV is contracted through skin-to-skin contact as opposed to the sharing of bodily fluids, such as semen and vaginal secretions. Oral HPV affects approximately one in 15 Americans, and is much more commonly contracted genitally, with a projected 80% of people having HPV in their lifetime. While HPV generally doesn’t require treatment since the body’s immune system tends to be well-equipped in fighting the infection, it’s noteworthy that HPV is the leading cause of oral and throat cancers, more so than even tobacco use.

Other sexually transmitted infections that are more commonly contracted through oral sex are gonorrhea and chlamydia. Unlike herpes, however, these STIs are usually fairly easy to treat with the use of antibiotics. The human immunodeficiency virus (HIV), may also be transmitted during oral sex, although this is incredibly rare. Furthermore, hepatitis and other bacterial infections may be transmitted during unprotected mouth-to-ass play.

Regardless of the STI in question, there is a greater risk of transmission when there is a cut and/or sore in the mouth, which allows these infections to pass into the bloodstream.

It’s important to note that many sexually transmitted infections are asymptomatic, meaning individuals who have contracted the STIs show extremely minor or no signs of the infections. Furthermore, while annual STI testing should be a tool in everyone’s sexual health arsenal, the fact is that patients are not regularly tested for oral sexually transmitted infections unless the individual is experiencing symptoms.

With all that said, it should come as no surprise that using safer sex precautions when engaging in oral sex is integral in limiting the spread of sexually transmitted diseases. This translates into using external condoms during fellatio (blowjobs), and dental dams during cunnilingus (good ol’ muff diving) and even analingus (anyone want to toss some salad?). If you don’t have any dental dams on hand, use saran wrap or make one out of a condom! These barrier methods allow individuals to engage in mouth-to-genital action without direct skin-to-skin contact, limiting the chances of STI transmission.

Unfortunately, the vast majority of individuals who engage in oral sex do not, in fact, use barrier methods. One study found that 82% of adults do not utilize these protective tools when engaging in oral sex, while another study suggested the same for 70% of adolescents. This is significant, not only from a public health perspective, but also because it leads to the conclusion that safer oral sex is something out of the norm, potentially making it especially difficult to have important conversations regarding barrier methods as people may often feel uncomfortable introducing such safety precautions into their sex lives. Furthermore, many people are resistant to the idea of condoms and dental dams during oral sex specifically, even if they welcome their use in other activities.

Although I can’t make sweeping generalizations on the topic, I’d hasten to suggest that there are two main reasons why people may be contrary to using barrier methods during oral sex: a lack of knowledge on the issue and a worry that protection will limit sensation. The former reason can be addressed by a casual conversation regarding the potential risk of STI transmission, and, if you’re regularly in contact with said sexual partner, by directing them to resources such as this Q&A.

Though the concern that barrier methods will make oral sex less “worth it” due to decreased pleasure also tends to be a common argument against using condoms during penetrative sex, just as with penis-in-vagina and penis-in-anus intercourse, safer sex is important in empowering people to care for their bodies, their health, as well as the bodies and health of their sexytime partners. Besides, what would the individual rather have: oral sex with a condom/dental dam, or no oral sex at all? When framed as a non-negotiable safety measure, I’d bet the resistant party will find themselves suddenly amenable to using protection.

Of course, like I previously mentioned, due to how relatively rare safer oral sex is practiced, it can be uncomfortable to introduce such measures into one’s sex life. Feeling unsure as to how to go about having such conversations? Try out these nifty scripts:

“I think you’re unbelievably sexy and would love to give you head, but I want to you to know that I make it a point to have safer oral sex.”

Another common concern regarding safer oral sex is the taste of latex; after all, not many people like a mouthful of plastic. Flavored condoms and lubricants can do wonders in addressing this issue. With that said, a note about flavored lubes: many of them contain glycerin, which may trigger yeast infections in those prone to them. For this reason, either opt for a flavored lube without glycerin, or make sure to not apply it directly to the vulva. Some great glycerin-free flavored lubricants include Sliquid Naturals Swirl and Nature Lovin’. You can also opt for flavorless silicone-based lubes such as Gun Oil and Uberlube. For lubricant and other sexual aid reviews, visit The CSPH Blog’s Center Stage Sexual Aid feature.

When you’re ready to go down, keep in mind that, just as with other forms of sexual play, safer sex precautions can be used to not only protect yourself or your partner, but also help to increase the sexual excitement from discovering the oyster, chewing brown, or licking a popsicle.

The CENTER for SEXUAL PLEASURE and HEALTH (The CSPH) is designed to provide adults with a safe, physical space to learn about sexual pleasure, health, and advocacy issues. Led by highly respected founder and director, Megan Andelloux, The CSPH is a sexuality training and education organization that works to reduce sexual shame, fight misinformation, & advance the sexuality field.